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Sunday, August 14, 2016

“Obesity is not widely considered a
protective mechanism,” Jason Fung begins his recent blog post. “Quite the opposite,” he
says. “It’s usually considered one of the causal factors of the metabolic
syndrome and insulin resistance.” In this, I had to agree. It is lamentable
that most physicians think this way, in large part because that is what
government sponsored research is predicated upon, and the standards of practice
of the various medical disciplines teach, and the medical associations preach.
Who can blame the clinician for believing it?

Jason Fung, however, is a thinker
(and a Canadian nephrologist), and he is free of those constraints – like TimNoakes, MD (who is South African), and Jay Wortman, MD, and Vilhjalmur
Stefansson (both also Canadians), and Gerald Reaven and Robert Atkins, both
U.S. MDs cast out by their profession, and Gary Taubes, who started it all for
many of us. The list of heretics is quite long – and growing daily – but Jason
Fung deserves singling out. He is a trailblazer. Like Gary Taubes’s magnum opus, “Good Calories, Bad
Calories” (2007), his target audience is medical professionals. But unlike
Taubes’s book, Fung’s “The Obesity Code” (2016), is “accessible.”

“I think obesity is a marker of disease,” Dr. Fung
continues, “but ultimately it serves to protect the body from the effects of
hyperinsulinemia. Let me explain.” Fung then references this recent New York Times article by Gina Kolata, which I read when it was
published. As a description of a rare case of a genetic disorder called
lipodystrophy (a lack of fat cells), I thought it was interesting. Fung,
however, calls this case “very interesting” and goes on to explain how it
relates in a causal way to metabolic syndrome and insulin resistance. It’s a
fascinating hypothesis. In an earlier blog post he calls it the new paradigm of insulin resistance.

“We need to understand the new paradigm of insulin resistance
to understand how insulin resistance, obesity, fatty liver, and fatty pancreas
are actually all the different forms of protection our body uses. But what is
the underlying disease? Hyperinsulinemia,” Dr. Fung says.

Fung then elaborates further upon the physiological mechanisms
of action that the body uses to protect itself from these manifestations. His
writing style is easy to follow – just ignore the charts and figures and follow
the prose. You’ll get it, I promise. And, if you seek this knowledge and
understanding, it’s a worthwhile read.

However, if you want to cut to the chase – the so-called
bottom line – these excerpts will spell it all out for you:

“There are many possible causes of too-much-insulin, but one
of the major ones is excessive dietary intake of refined carbohydrates and
particularly sugar.

“Insulin has several roles. One is to allow glucose into
cells. Another is to stop glucose production and fat burning in the liver
(gluconeogenesis). After this stops, then it stores glycogen in the liver and
turns excessive carbohydrates and protein into fat via de novo lipogenesis. Insulin is basically a hormone to signal the
body to store some of the incoming food energy, either as glycogen or fat.”

“There are two main problems with metabolic syndrome:
Glucotoxicity and insulin toxicity. It does no good to trade the increased
insulin toxicity to reduce glucotoxicity. That’s what we do when we treat
people with insulin or sulfonylureas. Instead, it only makes sense to reduce
BOTH glucotoxicity and insulin toxicity. Drugs such as SGLT2 Inhibitors do
this, but diet is obviously the best way. Low Carb diets. Intermittent Fasting.

In the end, obesity, fatty liver, and type 2 diabetes and all
the manifestations of the metabolic syndrome are caused by the same underlying
problem. NOT insulin resistance. The problem is hyperinsulinemia. It’s the
insulin, stupid.

“The power of framing the problem in this way is that it
unveils the solution immediately. The problem is too much insulin and too much
glucose. The solution is to lower insulin and lower glucose. How? Nothing
simpler. Low Carb, High Fat diets. Intermittent Fasting.

I think Jason Fung has really nailed it. I
wonder how long it will be before he is tarred and feathered and held in infamy
by his chosen profession. As Richard Feinman says in “The World Turned Upside
Down” (2016), being heretical is the price to be paid for being right. Or, has
the profession begun to turn the corner…and seen the light? Naaaw…..

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.